What are the three stages for treatment-based classification?

1. Determine appropriateness for PT vs referral or consultation

2. Determine severity and stability of pt’s symptoms

3. Match pt with most appropriate intervention

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Simplified model to 4 interventions for signs and symptoms LBP according to treatment based classification?

 Specific Exercise Manipulation Stabilization  Traction

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What is Centralization

in response to therapeutic loading strategies, pain is progressively abolished in a distal-to-proximal direction with each progressive abolition being retained over time until all symptoms are abolished”

- activity specific training

Principles of MDT?

 Utilizes progression of forces in treatment approach from least to most force

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Directional Preference

is the direction in which posturing or repeated movements cause pain to decrease and/or abolish, or centralize and ROM increases

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Centralized

indicates that all distal pain has abolished and that the pt has only central LBP.

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Centralization of LE symptoms:

Foot to ankle to calve to thigh to buttock to back

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Peripheralization

the phenomenon by which proximal symptoms originating from the spine are progressively produced in a proximal to distal direction

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Peripheralized

Indicates application of inappropriate loading strategies that have caused distal symptoms that were produced to last

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Disc model Flexion

Anterior disc compressed and posterior annulus stretched

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Disc model extension

Posterior disc compressed and anterior annulus stretched

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Postural Syndrome

 Pain remains local only to lumbar spine and is time-dependent  No LE pain and no parasthesias Lumbar ROM is full and painfree

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Dysfunction Syndrome

 Named according to direction of movement loss Similar to tissue shortening, scar tissue, etc. Pain is local to lumbar spine. No LE pain and/or parasthesias Pain present >8 weeks No pain at rest, only at end-range ROM Will likely see loss of ROM in 1 direction (i.e. full lumbar ROM except for extension)

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Derangement syndrome

Hallmark is rapid change in symptom severity and location with repeated motions

 Patient can have pain at rest, during movement, and at end-range of movement Pain onset can be acute or chronic Pain &/or paresthesias can be in spine or LE Disc or other tissue is obstructing motion. Utilize repeated movements to “clear the obstruction” Utilizing disc model and patient’s history allows for hypothesis of best treatment approach

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Posterior derangement prefer what based movement ?

prefer extension based movement

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Posterolateral derangement prefer what based movement ?

combined with extension and lateral based movements

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Anterior derangement prefer what based movement ?

Flexion based movement

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Anterolateral derangement prefer what based movement ?

combined flexion and laterally based movements

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lateral shift

- named according to the side shoulders are deviated towards- easily visible- disappear at rest